Provider Demographics
NPI:1316753205
Name:BOLTON, DIONE MITCHELL
Entity type:Individual
Prefix:
First Name:DIONE
Middle Name:MITCHELL
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 QUEEN BETH DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6360
Mailing Address - Country:US
Mailing Address - Phone:743-258-8604
Mailing Address - Fax:336-285-8554
Practice Address - Street 1:4203 QUEEN BETH DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6360
Practice Address - Country:US
Practice Address - Phone:743-258-8604
Practice Address - Fax:336-285-8554
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC7713253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care